吸气和呼气 CT 之间的流明区域变化作为衡量哮喘严重后果的指标
2018/05/03
摘要
背景：定量计算机断层扫描（QCT）气道形态生物标记有助于了解和监测哮喘区域气道重塑。
目的： 我们试图确定从CT影像数据测量的TLC和FRC肺容量之间的气道流明区域变化是否与哮喘患者的严重后果相关。
方法：我们通过定量计算机断层扫描（QCT）研究了152名哮喘患者（90名女性和62名男性）以及33名健康志愿者（12名女性和21名男性）。1-5级气道（1=气管）的后处理结果以壁面积百分比（WA%），壁厚度百分比（WT%），基线TLC及FRC流明区域（LATLC和LAFRC），FRC低密度区的形式呈现。我们定义了Delta流明，一种新的反映重塑和/或末梢气流陷闭程度的度量，即流明区域百分比归一化差异，公式为（LATLC-LAFRC）/LATLCx 100。
结果：我们对4501个气道段进行后处理（其中3681个气道段从152名哮喘患者受试者获取，820个气道段从33名正常受试者获取，每位受试者选取17-28个气道段）。结果显示，Delta流明与WT%呈负相关，哮喘患者受试者的Delta流明降低了6个单位（p<0.01）。3-5级气道（段支气管）的Delta流明在由于哮喘恶化住院和难治性哮喘而接受全身糖皮质激素治疗的受试者中显著降低。WT%和低密度区与全身性糖皮质激素治疗呈正相关，Delta流明与全身性糖皮质激素治疗呈负相关，提示降低的Delta流明对重症哮喘来说是一种潜在的预后生物标记。
结论：通过QCT测量所得到的中心气道降低的Delta流明，对于不稳定性难治性哮喘来说，是一种未来研究中值得继续探索的生物标记。
Lumen area change (Delta Lumen) between inspiratory and expiratory CT as a measure of severe outcomes in asthma.
Sung Shine Shim, et al.
Abstract
BACKGROUND：Quantitative computed tomography (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthma.
OBJECTIVE：We sought to determine if the change of airway lumen area between TLC and FRC lung volumes measured from CT imaging data was correlated with severe outcomes in
asthma patients.
METHODS：We studied 152 asthma patients (90 female and 62 male) and 33 normal subjects (12 female and 21 male) with QCT. Post-processing of airways at generations 1-5 (1 =trachea) was performed for wall area percent (WA%), wall thickness percent (WT%), lumen area at baseline TLC (LATLC) and FRC (LAFRC) and low attenuation area at FRC. A new metric (reflecting remodeling and/or distal air trapping), Delta Lumen, was determined from the percent normalized difference in lumen area defined as (LATLC - LAFRC ) / LATLC x 100.
RESULTS：Post-processing of 4501 airway segments was performed (3681 segments in the 152 subjects with asthma and 820 segments in the 33 normal subjects, range 17-28 segments per subject). Delta Lumen was negatively correlated with WT% and low
6 attenuation area (p<0.01) in asthma subjects. Delta Lumen was significantly lower for airway generations 3-5 (segmental airways) in subjects undergoing hospitalization due to exacerbation and in refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively, and Delta Lumen was negatively, associated with systemic corticosteroid treatment (p<0.05) suggesting reduced Delta Lumen is a potential outcomes biomarker in severe asthma.
CONCLUTIONS：Reduced Delta Lumen of the central airways measured on QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.
背景：定量计算机断层扫描（QCT）气道形态生物标记有助于了解和监测哮喘区域气道重塑。
目的： 我们试图确定从CT影像数据测量的TLC和FRC肺容量之间的气道流明区域变化是否与哮喘患者的严重后果相关。
方法：我们通过定量计算机断层扫描（QCT）研究了152名哮喘患者（90名女性和62名男性）以及33名健康志愿者（12名女性和21名男性）。1-5级气道（1=气管）的后处理结果以壁面积百分比（WA%），壁厚度百分比（WT%），基线TLC及FRC流明区域（LATLC和LAFRC），FRC低密度区的形式呈现。我们定义了Delta流明，一种新的反映重塑和/或末梢气流陷闭程度的度量，即流明区域百分比归一化差异，公式为（LATLC-LAFRC）/LATLCx 100。
结果：我们对4501个气道段进行后处理（其中3681个气道段从152名哮喘患者受试者获取，820个气道段从33名正常受试者获取，每位受试者选取17-28个气道段）。结果显示，Delta流明与WT%呈负相关，哮喘患者受试者的Delta流明降低了6个单位（p<0.01）。3-5级气道（段支气管）的Delta流明在由于哮喘恶化住院和难治性哮喘而接受全身糖皮质激素治疗的受试者中显著降低。WT%和低密度区与全身性糖皮质激素治疗呈正相关，Delta流明与全身性糖皮质激素治疗呈负相关，提示降低的Delta流明对重症哮喘来说是一种潜在的预后生物标记。
结论：通过QCT测量所得到的中心气道降低的Delta流明，对于不稳定性难治性哮喘来说，是一种未来研究中值得继续探索的生物标记。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（J Allergy Clin Immunol 2018 Feb 10 J Allergy Clin Immunol 2018 Feb 10）
（J Allergy Clin Immunol 2018 Feb 10 J Allergy Clin Immunol 2018 Feb 10）
Lumen area change (Delta Lumen) between inspiratory and expiratory CT as a measure of severe outcomes in asthma.
Sung Shine Shim, et al.
Abstract
BACKGROUND：Quantitative computed tomography (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthma.
OBJECTIVE：We sought to determine if the change of airway lumen area between TLC and FRC lung volumes measured from CT imaging data was correlated with severe outcomes in
asthma patients.
METHODS：We studied 152 asthma patients (90 female and 62 male) and 33 normal subjects (12 female and 21 male) with QCT. Post-processing of airways at generations 1-5 (1 =trachea) was performed for wall area percent (WA%), wall thickness percent (WT%), lumen area at baseline TLC (LATLC) and FRC (LAFRC) and low attenuation area at FRC. A new metric (reflecting remodeling and/or distal air trapping), Delta Lumen, was determined from the percent normalized difference in lumen area defined as (LATLC - LAFRC ) / LATLC x 100.
RESULTS：Post-processing of 4501 airway segments was performed (3681 segments in the 152 subjects with asthma and 820 segments in the 33 normal subjects, range 17-28 segments per subject). Delta Lumen was negatively correlated with WT% and low
6 attenuation area (p<0.01) in asthma subjects. Delta Lumen was significantly lower for airway generations 3-5 (segmental airways) in subjects undergoing hospitalization due to exacerbation and in refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively, and Delta Lumen was negatively, associated with systemic corticosteroid treatment (p<0.05) suggesting reduced Delta Lumen is a potential outcomes biomarker in severe asthma.
CONCLUTIONS：Reduced Delta Lumen of the central airways measured on QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.
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小气道功能异常：过敏性鼻炎和过敏性哮喘之间的联系
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从医院治疗哮喘急性加重恢复期间获得的参数定义的哮喘表型
